Princess Health and Ashland hospital expands into wellness and prevention programs. Princessiccia

Princess Health and Ashland hospital expands into wellness and prevention programs. Princessiccia

diabetes employers health insurance hospitals jobs physical activity prevention wellness

Gusty 06:12 Add Comment

By Judi Kanne
Kentucky Health News

Hospitals� basic business is taking care of the sick and injured, not keeping people from getting sick. But more and more of them are getting into wellness and prevention, not only to help their communities but to make money.

King's Daughters Heart and Vascular Center

One of those is King�s Daughters Medical Center in Ashland, which has developed an innovative strategy for building relationships with local employers to help their employees live healthier lives.

King�s Daughters began by focusing on self-insured employers, who can get the most direct benefit from reduced health-care expenses. It used one-to-one employer outreach activities such as a farm-to-table employer lunch, to which more than 126 local employers were invited.

The first question for employers, said Matt Ebaugh, vice president and chief strategy officer at King�s Daughters, is �Do you understand what is driving the cost for your employees?� because �Self-funded employers do not always have the analytics or tools needed to understand where those costs come from.�

King�s Daughters used Strategic Health Services of Alpharetta, Ga., to create a portal for health risk assessment, biometric screening results, claims analytics and personal health profiles of employees.

While the program is aimed at wellness, it also finds new cases for the hospital. �We knew if we did a smart thing for local employers, demonstrated value, and coupled it with good customer service, then when employees needed a higher level of care, they would come to us,� Ebaugh said.

By means of screenings for diabetes, cholesterol, and body mass index, employees become patients.

Diabetes screening can be critical. About 86 million American adults are pre-diabetic, but nine out of 10 people who are don�t know it, according to the federal Centers for Disease Control and Prevention. That can be detected with health-risk assessment lifestyle questionnaires.

Beyond individual screenings, hospitals can examine the emerging risks in a population using claims data. That can also help them show employers what�s driving up their costs. Claims also indicate which employees are most likely to use hospital and pharmacy services.

�We need to find innovative ways to motivate individuals to change old and dangerous patterns,� Ebaugh said, because simple lifestyle changes can dramatically cut the risk for developing diabetes.

But getting healthy may require offering financial and other incentives to get people to participate in wellness programs. The Ashland hospital plans to try gamification, incorporating into the workday a set of programmed games and activities that remind sedentary employees to get up, stretch, and move around.

The idea is to make health and fitness fun, a social experience and accessible to as many members as possible. Gamification programs include computer notifications or other reminders that stimulate sedentary disruption and track activity. In some cases, motivation includes team competition in which employees win points by stopping to stretch.

Ebaugh said such programs have been shown to work and are critical in some cases, because a pre-diabetic employee may not be motivated enough to change eating and exercise patterns. �Knowing is not enough,� he said. �We anticipate the energy and participation with gamification will increase as a result of more engaging activities.�

The hospital first started a wellness program for its own employees, and plans to add gamification to it, Ebaugh said: �It�s important our model work well to show our employers the success we are having with our internal employees.�

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

Princess Health and Kentucky Center for Economic Policy report warns about impact of Bevin's proposed Medicaid changes. Princessiccia

Princess Health and Kentucky Center for Economic Policy report warns about impact of Bevin's proposed Medicaid changes. Princessiccia

economy federal spending health reform jobs Medicaid obamacare Patient Protection and Affordable Health Care Act politics prevention state budget state government

Gusty 13:15 Add Comment

By Danielle Ray

Kentucky Health News

A research group with a liberal outlook warned Monday that Republican Gov. Matt Bevin should be careful in changing the state Medicaid program.

The Kentucky Center for Economic Policy said the state�s expansion of Medicaid eligibility under Democratic Gov. Steve Beshear has increased health screenings and job growth in health care.

Tobacco counseling and interventions increased 169 percent from 2013 to 2014, the first year of the expansion, the report noted. Influenza vaccinations went up 143 percent and breast cancer screenings increased 111 percent, it noted.

In addition, Medicaid expansion brought Kentucky health-care providers nearly $3 billion through mid-2015 and resulted in a 4.6 percent job growth in the health-care sector from 2014 to 2016, according to the report.

�No matter how you look at Medicaid expansion in Kentucky, it�s clear it has had a positive effect on access to health care that will improve our state�s economy and quality of life,� Jason Bailey, executive director of KCEP, said in a news release.

However, Bevin says the state can�t afford to have more than a fourth of its population on Medicaid and is seeking a waiver from the federal government to make changes in the program, such as �skin in the game� for beneficiaries: co-payments, deductibles or health savings accounts, as used in a year-old experiment in Indiana, which he has cited as an example.

The KCEP reports says the Medicaid waiver Bevin is seeking could result in additional costs to recipients and benefit changes. Arkansas was the first state to design a Medicaid expansion using such a waiver. So far, five other states have implemented similar waiver-based programs.

Waiver programs differ from standard Medicaid expansion in that they utilize some or all of the following: health savings accounts, a cost-sharing account to be used for health care expenses; lockouts, periods in which recipients who have been dis-enrolled for failure to pay premiums are barred from re-enrolling; and premium assistance, the use of Medicaid funds to buy private insurance plans.

These waivers are designed to grant states the freedom to enact experimental programs within Medicaid, so long as the programs continue to reflect the overall goal of Medicaid, increasing coverage of low-income individuals and improving overall health care, as well as efficiency and stability of health care programs that serve that population.

The Foundation for a Healthy Kentucky, which convened a meeting of Medicaid stakeholders last week, is holding off on making judgments of the proposed waiver program. �We believe that diverse input is essential to sustaining these gains, and to continue improving our health care system and health outcomes in Kentucky,� said Susan Zepeda, president of the foundation.

Zepeda said research the foundation has funded has shown a greater decrease in the number of Kentuckians who lack health insurance than any other state, which she attributes largely to Medicaid expansion adding about 400,000 Kentuckians to the rolls.

More than 1.4 million Kentuckians are enrolled in Medicaid, 39 percent of whom are children. Nearly 32 percent are enrolled under the expansion: childless adults in households that earn less than 138 percent of the federal poverty line, currently $33,000 for a family of four.

The KCEP report also asserts that Kentucky�s Medicaid benefits are on par with those of other states, specifically that 12 out of 13 of Kentucky�s optional benefits are also covered in at least 40 other states and territories. Kentucky Medicaid only covers services that are deemed medically necessary.

KCEP noted that Medicaid is a partnership in which the federal government funds a minimum of half of traditional Medicaid spending in each state, with poorer states receiving a larger federal match. In Kentucky, the federal share is about 70 percent. For people covered by the expansion, the federal government is paying the full cost through this year, but the state will pay 5 percent in 2017, rising in annual steps to the law�s limit of 10 percent in 2020.

The full KCEP report is at http://kypolicy.org.

Princess Health and Republican legislators question cabinet's figures on managed-care payments and cost projections for Medicaid expansion.Princessiccia

Princess Health and Republican legislators question cabinet's figures on managed-care payments and cost projections for Medicaid expansion.Princessiccia

General Assembly health insurance jobs legislature managed care Medicaid politics state government

Gusty 05:42 Add Comment

Audrey Haynes (cn|2 image)

"When Audrey Haynes sat down before the legislature�s Medicaid Oversight and Advisory Committee Wednesday, she expected the data she brought would persuade lawmakers that Kentucky�s expansion of Medicaid has been good for the state," Ronnie Ellis reports for CNHI News Service. "The secretary of the Cabinet for Health and Family Services, which administers the Medicaid program also may have expected her statistics to ease unhappiness with the state�s move to managed care for most Medicaid services."

"It didn�t happen," Ellis writes. "At least she didn�t persuade Republican members who openly questioned the validity of the cabinet�s data, a couple stopping just short of saying the cabinet is making up the numbers" about payments to providers by managed-care organizations, which it says are 99 percent on time. �The numbers do not appear to represent the reality on the ground,� Rep. Richard Benvenuti, R-Lexington, said after the meeting.

Sen. Ralph Alvarado

�I think those are false,� Sen. Ralph Alvarado, R-Winchester, said after the meeting. �I don�t know if they�re lying, but somebody is providing bad information.�

During the meeting, Alvarado read "segments of letters from providers who have not received full reimbursements from managed care organizations," reports Kevin Wheatley of cable channel cn|2's "Pure Politics."

"Haynes referenced a report from CHFS which showed that over 90 percent of Medicaid claims are being paid in a timely manner," reports the blog of the Kentucky Chamber of Commerce. "Sen. Alvarado replied that this statistic does not match what he is hearing from his constituents and medical providers." Haynes addressed the managed-care issue in her PowerPoint presentation, downloadable here.

Rep. David Watkins, D-Henderson, a retired physician and co-chair of the committee, "urged the panel to find ways to improve managed care."

Watkins said the managed-care organizations, which are insurance companies or their subsidiaries, should come before the committee to answer questions. �I�m not totally satisfied that they�re doing quite as good a job as your report here would portray,� he told Haynes. �I think they need to be more accountable. I think they need to be more responsive to the providers who actually are doing work in the field.�

The MCOs will appear before the joint House-Senate committee Aug. 19, Brad Bowman reports for The State Journal in Frankfort. For cn|2's three-minute clip of the discussion between Haynes and Alvarado, via YouTube, click here.

The Republican lawmakers also voiced skepticism, but offered no contrary evidence, about the cost of expanding Medicaid to households with incomes up to 138 percent of the federal poverty level, from the previous limit of 69 percent. Under the Patient Protection and Affordable Care Act, the federal government is paying the entire cost of the expansion until next year, when the state will begin paying a small part, rising to the law's cap of 10 percent in 2020.

Haynes noted projections for Democratic Gov. Steve Beshear's administration that the expansion would add $30.1 billion to the state's economy through 2021, and would pay for itself until then, even after the state starts picking up part of the cost. The numbers were not new; they were part of a study by Deloitte Consulting and the University of Louisville that Beshear released in February.

Republicans focused on the prediction that the expansion would cost the state a net $45 million in 2021. "I know that seems like a way long ways off and some of you may no longer even be in the position to deal with it, but some of us probably will and the taxpayers will," said Alvarado, a physician.

Haynes "stated that she believed with the financial boost to the economy through jobs, the costs will be offset," the blog of the Kentucky Chamber of Commerce reports.

�Now that we�re seeing the lowest unemployment that we�ve seen in our state in quite a number of years, I�m sure each of you are amazed at how that we�ve had all 120 counties in our state where the unemployment rate has gone down,� Haynes said. �As this state continues to generate revenue and hopefully, as is planned, this is a bridge program for people who basically are hard-working people, but their employer does not provide insurance or they have children and therefore that qualifies them from an income basis for Medicaid.�

Princess Health and Princess Health andCarlisle hospital closes, making Nicholas County the 40th Kentucky county without a hospital.Princessiccia

Princess Health and Princess Health andCarlisle hospital closes, making Nicholas County the 40th Kentucky county without a hospital.Princessiccia

health reform hospitals jobs rural-urban disparities

Gusty 13:04 Add Comment

Fully one-third of Kentucky's counties will not have a hospital, following the closure of Nicholas County Hospital in Carlisle. That will make Nicholas the 40th county without a hospital, according to the Kentucky Hospital Association.

The hospital board said it searched "every possible option to keep the hospital open," but it has filed for bankruptcy and will close later this week, reports WLEX-TV. Officials reported that the 14-bed hospital was losing more than $100,000 per month, which they say resulted from a decrease in the number of patients and slow state and federal reimbursements, Sam Smith reports for WKYT-TV.

"It's a trickle-down effect that's going to impact the entire community and then there's the more critical life-saving aspect. There's a number of people within the community who are alive today because they were able to receive treatment at the hospital," hospital spokesman Stephen Scalf told WKYT.

Scalf said the hospital's clinics will close by Friday except for one rural health clinic that will likely remain open. Johnson Mathers Nursing Home, which operates on the same campus as the hospital, will not close. "Nicholas County Hospital is operated by a private nonprofit organization, JMHC Inc., and has 44 full-time and 40 part-time employees who are being laid off," Karla Ward reports for the Lexington Herald-Leader.

The hospital's board said in a news release that it has been negatively affected by a national transition to "larger, urban-centered hospitals' that had forced many other rural health centers to close."

The fiscal court will be looking for options to create an "urgent treatment or ambulatory care facility that will provide for the community's medical needs in the future," WLEX reports. The county owns the hospital's property, and Judge-Executive Mike Pryor said other healthcare provers are considering taking over the space, Smith reports. "It's just another hit to us," said Pryor. "It's going to be something we are going to have to deal with, like we have in the past."

Princess Health and Princess Health andPaducah Sun editorial criticizing Medicaid expansion was off base; Beshear sends the newspaper a response.Princessiccia

Princess Health and Princess Health andPaducah Sun editorial criticizing Medicaid expansion was off base; Beshear sends the newspaper a response.Princessiccia

health reform jobs Medicaid newspapers obamacare research state budget state government taxes

Gusty 18:58 Add Comment

By Al Cross
Kentucky Health News

The Paducah Sun relied on incomplete and inaccurate information for an editorial Thursday that criticized Gov. Steve Beshear's expansion of the Medicaid program under federal health-care reform, and the governor is complaining about it.

The newspaper said Beshear had created a "financial mess" because when he was running for governor, he "told our editorial board that he had 'no idea where we would get the money' to pay the state's share of the cost of Medicaid expansion if the Affordable Care Act was passed. He still doesn't."

Actually, when he announced the Medicaid expansion a year ago, Beshear cited a study by the international accounting firm PricewaterhouseCoopers which concluded that the expansion would pay for itself by adding patients to the health-care system and creating 17,000 jobs by the 2020-21 fiscal year.

The editorial made no mention of the study. Beshear's communications director, Kerri Richardson, told the paper Tuesday that the editorial was "grossly misleading, and we are disappointed that your editorial board has chosen not to seek information from anyone in our administration regarding actions on the Affordable Care Act."

In the formal response from Beshear, submitted for publication, the governor says the editorial "was so breathtakingly disingenuous that it demands a factual response. That a newspaper of this size would trot out such unsubstantiated tripe disguised as analysis is a disservice to its readers."

Sun Editor Steve Wilson said the editorial was written by Publisher Jim Paxton, who did not return a call seeking comment. The Sun's editorials generally support conservative causes and Republicans; Beshear is a Democrat and the only Southern governor to both expand Medicaid and create a health-insurance exchange under the reform law.

The editorial also misstated when Kentucky would have to start sharing in the cost of care for the newly eligible Medicaid recipients, those with household incomes between 69 percent and 138 percent of the federal poverty level. It cited a study by the conservative Heritage Foundation which "suggests that even when savings from ACA managed-care features are added in, the expansion will cost Kentucky an additional $846 million between 2014 and 2022."

Actually, the state will not have to pay anything for the newly eligibles until 2017 because the federal government will pick up the entire cost until then. In 2017, the state will have to pay 5 percent of their cost, rising to a cap of 10 percent in 2020. Republican critics of the law have said the cap will have to be raised, but have not found fault with the study.

Studies by the accounting firm and the University of Louisville's Urban Studies Center, drawing on Congressional Budget Office data, estimated the state would actually gain $802 million through the 2020-21 fiscal year from Medicaid expansion. "Without expansion, our budget would see a negative impact of nearly $40 million, because we would be forced to absorb costs such as increased payments to hospitals for uncompensated care, " Beshear wrote. "In other words, the state would lose money if we didn�t expand." Click here for the rest of his reply.

Beshear said in his response that he sent the Sun an op-ed piece a year ago this week explaining the facts, but the paper apparently refused to publish it.

Princess Health and Princess Health andTobacco is top target in Beshear's health plans, but he still praises expansion of plant that makes smokeless tobacco.Princessiccia

Princess Health and Princess Health andTobacco is top target in Beshear's health plans, but he still praises expansion of plant that makes smokeless tobacco.Princessiccia

cigarette tax economy jobs local government smoking state government taxes tobacco

Gusty 14:27 Add Comment

Gov. Steve Beshear says tobacco is the main cause of Kentuckians' relatively poor health, which he is pushing to improve, but on Feb. 27 "his tone shifted as he praised the economic benefits from a tobacco company's plans to expand its Western Kentucky processing operations for smokeless tobacco products," reports Bruce Schreiner of The Associated Press.

U.S. Smokeless Tobacco Co., an Altria Group subsidary that makes Copenhagen and Skoal from local tobacco, says it will spend $118 million and create 42 jobs as it expands its 90-employee plant in Hopkinsville. Beshear called that "proof that Kentucky is a great place to grow a business." If the company creates the predicted number of jobs, it could get $4.5 million and $1.4 million, respectively, in state and local tax breaks.

Tobacco farming is a smaller part of Kentucky's economy today than it was for most of the 20th Century, but Schreiner notes the state has the nation's highest percentage of smokers and "has the worst or near-worst rates for smoking, cancer deaths, heart disease and high blood pressure." Smokeless tobacco is linked to cancer of the mouth, throat and esophagus.

Those are among the reasons Beshear's tax-reform plan would raise levies on cigarettes and smokeless tobacco. "He also touts legislation calling for a statewide smoking ban at workplaces and in public buildings," Schreiner notes. "Altria opposes any tobacco tax increases."

The American Cancer Society says smokeless tobacco can cause nicotine addiction, which can lead to smoking, and can also lead to gum disease and tooth decay. Oral health is one of the seven main points in Beshear's recently announced plan to improve the state's health, Schreiner notes.

Princess Health and Medicaid expansion could change Kentucky's course, big time.Princessiccia

Princess Health and Medicaid expansion could change Kentucky's course, big time.Princessiccia

Affordable Care Act eonomy health insurance health policy health reform jobs Medicaid Patient Protection and Affordable Care Act politics poverty state government

Gusty 20:57 Add Comment

NEWS ANALYSIS

By Al Cross

Kentucky Health News

"Today we change the course of Kentucky's history."

It is not often that a public official can say such a thing with a large measure of credibility, but Gov. Steve Beshear legitimately raised that hope Thursday, as he announced that he would expand Kentucky's Medicaid program under federal health reform.

Beshear with graph predicting positive impact on budget

If Beshear's vision is fulfilled, Kentucky will no longer have one of the unhealthiest populations of any state, a change that will make it more attractive to employers, and any Kentuckian who wants health insurance will be able to get it.

It is in large measure the realization, in the state where all President Harry Truman's grandparents were born, of his 68-year-old dream of national health insurance. The statue of Truman's vice president, Alben Barkley of Paducah, seemed to shine a little more brightly than usual in the Capitol rotunda as the press-conference crowd dispersed.

But this is a project with many moving parts -- billions of dollars, thousands of health-care providers, hundreds of thousands of Medicaid beneficiaries, and scores of political and bureaucratic decisions -- and much could go wrong.

Skeptics point to the problems with the managed-care Medicaid system that Beshear implemented too hurriedly, apparently to avoid complicating his November 2011 re-election, and argue that the program needs fixing before adding 300,000 new enrollees to the 825,000 already on the rolls. Beshear says he's tackling the problems, the program is "working pretty well" and the managed-care companies can handle the influx.

The skeptics also question whether the state can afford the match for the federal funds. "Broad and vague anxieties," Beshear called them, and he came armed with two studies concluding that expansion would actually gain the state money -- mainly because of the billions it will send to the state's health-care providers, creating more jobs, but also because many of the 300,000 or so newly eligible people are not expected to enroll, based on a Price Waterhouse Coopers study drawing on research by the Congressional Budget Office.

University of Louisville research

Preliminary estimates were that expansion would add 400,000 Kentuckians to the Medicaid rolls. However, the study estimated that only 308,000 will become eligible and that only 188,000 will enroll, thus costing the state much less than some expected when it has to match federal funds beginning in January 2017. The initial match will be 5 percent, rising to 10 percent in 2020. The estimated cost for the newly eligible in fiscal 2020-21 is $151 million, in a state budget that is likely to exceed $10 billion. (The state's current share of Medicaid costs, 29.5 percent, is about $1.5 billion a year.)

Those are just estimates. "I believe reality will dwarf those numbers on the spending side," Tea Party activist David Adams, who says he plans to challenge the plan in court, told reporters. But for the time being at least, Beshear has the numbers on his side, and he said they are "very conservative."

The governor said opponents of the plan "fall back on national politics" and say expansion means that Kentucky, a state that President Obama lost big both times, will be "supporting Obamacare. To them I say, 'Get over it.' . . . I'm going to do what's best for Kentucky's people, period." Asked why so many governors have rejected expansion, he said it was mostly "partisan politics."

Conservative columnist John David Dyche cites an Oregon study saying Medicaid is ineffective, but a Harvard School of Public Health study in three other states showed that expansion of Medicaid improves health and saves lives.

Beshear said the expansion, along with health insurance and subsidies available through a state-run exchange that is also part of health reform, would give the state a healthier workforce because studies show that people with health insurance are less likely to skip exams and let health conditions worsen and become costlier and more difficult to treat. "The lack of early care is one reason that Kentucky's health picture is so horrendous," he said.

Kentucky's workforce is one of the nation's least healthy, and the state has a disproportionate number of working-age people who are not in the workforce because of health problems. The state ranks first in smoking, cancer deaths and preventable hospitalizations; second in heart disease and poor physical-health days; third in heart attacks and poor mental-health days; and in the top 10 in diabetes,  cholesterol and sedentary lifestyles. That hurts the state's image as well as its economy, Beshear said. "There will be a huge economic effect for a healthier Kentucky."

He said most of the newly eligible people are not "freeloaders asking for a handout," but people who are working at jobs without health insurance. He said another 332,000 Kentuckians will get insurance through the state exchange, 276,000 of them with subsidies available to people with incomes up to 400 percent of the poverty level. Without Medicaid expansion, he said, 206,000 would not be eligible for Medicaid or a subsidy, and "We cannot leave those people stranded."

The health-reform law tried to force states into expanding Medicaid, but the U.S. Supreme Court ruled that the states should make the choice without fear of financial penalties. The law calls for expansion to cover people under 65 in households up to 138 percent of the federal poverty level -- currently $15,856 for an individual or $32,499 for a family of four.

Republicans can do little to stop the expansion. They control the state Senate, but Medicaid eligibility and benefit decisions belong to the executive branch, and even if a bipartisan legislative committee were to block the implementing regulations, Beshear could override it.

Or perhaps we should say he would override it. Emotional at times, Beshear called the move "the single most important decision of our lifetime for improving the health of Kentuckians" but said it was easy to make. As a governor who has failed to win his main campaign promise, expanded gambling, and has had relatively little money to spend because of the Great Recession, this is likely to be his largest legacy.

For details and background from the governor's office, click here. For Beshear's YouTube commentary on the issue, click here.

Princess Health and 28% of Ky. adults 18-64 say they lack health coverage; 41% lacked it sometime in last year; employer coverage down since '08.Princessiccia

Princess Health and 28% of Ky. adults 18-64 say they lack health coverage; 41% lacked it sometime in last year; employer coverage down since '08.Princessiccia

economy Foundation for a Healthy Kentucky health care access health insurance jobs poll recession

Gusty 13:38 Add Comment

Nearly three in 10 working-age adults in Kentucky are not covered by any form of health insurance, and the number who get health insurance from their employer, or their spouse�s employer, has plummeted since 2008, the first year of the Great Recession, according to the latest Kentucky Health Issues Poll. The decline accelerated in the last year, and was accompanied by a big jump in the percentage on public insurance.

The poll, taken Sept. 20 through Oct. 14, found that 28 percent of adults aged 18 to 64 said they had no health insurance at the time they were interviewed, and 41 percent said they had been uninsured at some point in the previous year.

The survey found that 37 percent get their insurance from an employer or spouse�s employer, well below the 55 percent figure in a similar poll in 2008. Conversely, 27 percent are now covered by some form of public insurance, way up from the 10 percent in 2008.

Medicaid in Kentucky covers households with incomes up to 70 percent of the federal poverty threshold; 43 percent of working-age adults living at or below that level reported being uninsured last fall. Among those with incomes more than double the poverty level for their size household, 15 percent said they were uninsured.

The poll was conducted for the Foundation for a Healthy Kentucky and the Health Foundation of Greater Cincinnati by the Institute for Policy Research at the University of Cincinnati. Pollsters contacted a random sample of 1,680 adults throughout Kentucky by telephone, including landlines and cell phones. The poll questioned only working-age adults about insurance because 98 percent of seniors have some form of health coverage. The poll has a margin of error of plus or minus 2.5 percentage points.

Princess Health and Appalachian Regional Healthcare asks federal judge to make managed-care firm keep it under contract.Princessiccia

Princess Health and Appalachian Regional Healthcare asks federal judge to make managed-care firm keep it under contract.Princessiccia

Appalachia health insurance hospitals jobs Medicaid politics poverty rural health state budget state government

Gusty 12:45 Add Comment

Appalachian Regional Healthcare, a hospital chain in Eastern Kentucky and southern West Virginia, is seeking an emergency injunction by a federal judge ordering Coventry Cares to let its Kentucky members continue receiving services from the hospitals, and to avoid widespread layoffs the chain says will happen if the judge doesn't intervene, reports Bill Estep of the Lexington Herald-Leader. Coventry Cares is one of three state-approved companies to provide managed care services through Medicaid. It said it would cancel its ARH contract after Friday, which would affect about 25,000 Medicaid recipients.

With a few exceptions, Coventry members would lose access to treatment or have to travel long distances to get to other facilities approved by the company, which ARH and officials in affected counties say would be difficult for most because they don't have money or reliable transportation to make the trip. Coventry spokesman Matthew Eyles said the company would continue paying for some services at ARH hospitals, including ob-gyn services to women who are more than 12 weeks pregnant and have a relationship with an ARH doctor.

The state switched to managed-care last year as a way to save money, but as Estep reports, the move has been "rocky." Providers have complained about delayed payments from the companies and their cumbersome pre-approval processes for treatments. ARH sued Coventry and Kentucky Spirit, another provider, claiming the companies owed more than $18 million for services ARH had provided.  Estep notes, "The state allowed another managed care provider not to include ARH in its network, which meant a lot of higher-risk, higher-cost patients ended up covered by Coventry, the company said." The company also said the state failed to implement a method to assess risks that would adequately compensate managed-care providers who have more high-risk patients."

ARH and its Coventry patients think the company is trying to get more money out of the state. Many of ARH's patients are covered by Coventry, and ARH spokeswoman said about 300 to 400 jobs would be cut if Coventry cancels its contract. State officials are encouraging continues negotiation between ARH and Coventry. (Read more)

Meanwhile, Bardstown pediatrician and Passport Health Plan board member James Hendrick wrote a letter to the editor of The Courier-Journal offering Passport's services to "help the state get Medicaid back on track." He said he's been very impressed with the nonprofit's "strong and engaged provider network, and an intense focus on delivering services at a cost that doesn�t diminish quality," adding that because Passport is a nonprofit, it's not concerned with appeasing shareholders. Passport has been managing Medicaid in the Louisville region for several years.